<div class="main-l fll">
	<div class="breakcrum ov-h clb">
    	<div class="title"><span><a href="<?php echo base_url();?>home" class="home"><?php echo $this->lang->line('system_home'); ?></a><!--<a href="<?php echo base_url();?>contact"><?php echo $this->lang->line('system_contactus'); ?></a>--></span></div>
    </div>
    <div class="contact ov-h mb-10">

    	<h3>Đăng ký du học trực tuyến</h3>

    </div>
    <div class="contact-fr box ov-h clb">
    	<?php if (!isset($success)){ ?>
    	<form name="contact_form" method="POST" action="<?php echo base_url();?>contact/register">
        	<label><strong><?php echo $this->lang->line('system_fullname'); ?> <span>(*)</span></strong><input type="text" name="name" /></label>
        	<label style="width:150px;float:left;margin-top:0px;margin-bottom:15px;"><strong><?php echo $this->lang->line('system_birthday'); ?> <span>(*)</span></strong></label>
<!--        	<input type="text" name="birthday" />-->
			<span style="float:left;">
			<select name="day" id="day">
				<option value=""><?php echo $this->lang->line('system_day'); ?></option>
				<?php for ($i=1;$i<=31;$i++){
					?>
				<option value="<?php echo $i ;?>"><?php echo $i ;?></option>
				<?php
				} ?>
			</select>
			<select name="month" id="month">
				<option value=""><?php echo $this->lang->line('system_month'); ?></option>
				<?php for ($i=1;$i<=12;$i++){
					?>
				<option value="<?php echo $i ;?>"><?php echo $i ;?></option>
				<?php
				} ?>
			</select>
			<select name="year" id="year">
				<option value=""><?php echo $this->lang->line('system_year'); ?></option>
				<?php
					$year=1969;
					$now=(int) date("Y")+1;
					$c=$now - $year;

				for ($i=$c;$i>1;$i--){
					$now --;
					?>
				<option value="<?php echo $now ;?>"><?php echo $now ;?></option>
				<?php
				} ?>
			</select>
			</span>

            <label><strong>Email <span>(*)</span></strong><input type="text" name="email" /></label>
            <label><strong><?php echo $this->lang->line('system_phone'); ?></strong><input type="text" name="phone" /></label>
            <label><strong><?php echo $this->lang->line('system_address'); ?></strong><input type="text" name="address" /></label>
            <label><strong><?php echo $this->lang->line('system_education'); ?></strong><input type="text" name="education" /></label>
            <label><strong><?php echo $this->lang->line('system_message'); ?> <span>(*)</span></strong><textarea name="message"></textarea></label>
            <label><strong>&nbsp;</strong><input type="submit" name="" value="<?php echo $this->lang->line('system_register'); ?> " /></label>
        </form>
      <?php } else { echo $this->lang->line('system_regsuccess'); } ?>
    </div>
    <div class="clb"></div>
</div>